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LITTLE CANADA PARKS & RECREATION DEPARTMENT <br />Program Survey <br />Telephone: 484 -2177 Fax: 484 -4538 <br />Little Canada Parks & Recreation Commission is trying to determine the need for additional program offerings. <br />Please complete the following survey by circling the letter next to your desired response. Read each item carefully <br />and feel free to comment on any question in the space provided on the back of this form. Thank you for your <br />participation! <br />1. Our household presently participates in activities being provided by the Little Canada Parks & <br />Recreation Department. <br />(a) regularly <br />(b) sometimes (c) never <br />2. Age group of household members (write in quantity): <br />(a) under 12 ____ (b) 12 -18 (c) 18 -45 _ (d) 45 -60 (e) over 60 ____ <br />3. Please rate your satisfaction with programs currently being provided. <br />(a) very satisfied (b) satisfied (c) dissatisfied (d) no comment <br />4. From the list below, please select which new program(s) you would participate in if offered. All <br />programs would be fee -based and self- supporting. <br />(a) arts and craft classes <br />(b) card games <br />(c) chess matches <br />(d) community events (such as holiday events) <br />(e) community music events <br />(f) community theater <br />(g) computer clubs <br />(h) educational programs <br />(i) field trips <br />(j) gardening clubs <br />(k) nature center volunteers program <br />(1) physical fitness for the 25 to 60 age group <br />(m) programs for disabled (such as wheelchair basketball) <br />(n) sand volleyball <br />(o) other <br />5. If summer concerts in the park were provided on a regular basis, I or my family would attend: <br />(a) regularly <br />(b) sometimes (c) never <br />VOLUNTEERS NEEDED! <br />If you wish to volunteer to assist with any programs offered by the Little Canada Parks & Recreation Department, <br />please include your name, address, and phone number below. Thank you. <br />Name: <br />Address: <br />Page 1 <br />Phone #: <br />